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Incident Investigation Form

Incident Investigation Form Template for New Zealand

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Key Requirements PROMPT example:

Incident Investigation Form

"I need an Incident Investigation Form for our manufacturing facility that complies with New Zealand WorkSafe requirements and includes specific sections for machinery-related incidents and chemical exposure, with extra emphasis on root cause analysis and corrective action tracking."

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Document background
The Incident Investigation Form is a crucial document required under New Zealand's health and safety legislation, particularly the Health and Safety at Work Act 2015. This document must be completed following any workplace incident, accident, or significant near-miss to document the event, identify root causes, and determine preventive measures. The form supports compliance with WorkSafe NZ reporting requirements and ACC claims processes while providing a structured approach to incident investigation. It captures essential information including incident details, witness statements, investigation findings, and corrective actions, serving as both a legal record and a tool for organizational learning and risk management. The document is designed to be comprehensive enough to meet regulatory requirements while remaining practical for use across different industry sectors and organizational sizes.
Suggested Sections

1. Incident Details: Basic information including date, time, location, and type of incident

2. Person(s) Involved: Details of all people involved including injured parties, witnesses, and investigators

3. Incident Description: Detailed narrative of what happened, including sequence of events

4. Immediate Actions Taken: Steps taken immediately after the incident to secure the scene and ensure safety

5. Investigation Findings: Analysis of root causes, contributing factors, and investigation methodology

6. Evidence Collected: List and description of physical evidence, photographs, documents, and witness statements

7. Risk Assessment: Evaluation of the risk level and potential consequences

8. Corrective Actions: Specific actions required to prevent recurrence

9. Notifications: Record of required notifications to authorities (e.g., WorkSafe NZ, ACC)

10. Sign-off: Approval and verification by relevant authorities (manager, H&S representative)

Optional Sections

1. Environmental Impact Assessment: Required when incident involves environmental damage or potential contamination

2. Equipment/Machinery Investigation: Detailed analysis when incident involves equipment failure or malfunction

3. Contractor Management: Required when incident involves contracted workers or services

4. Return to Work Plan: Required for incidents resulting in injury requiring time off work

5. Cost Analysis: Assessment of financial impact when significant property damage or business interruption occurs

6. Drug and Alcohol Testing Results: Required when substance testing was conducted as part of investigation

Suggested Schedules

1. Witness Statement Forms: Template forms for recording witness accounts

2. Scene Diagram Template: Grid paper and guidelines for sketching incident scene

3. Risk Matrix: Standard risk assessment matrix for evaluating incident severity and likelihood

4. Notification Requirements Checklist: List of authorities to be notified based on incident type

5. Investigation Methodology Guide: Standard procedures and methods for conducting investigation

6. Evidence Collection Checklist: Standardized list for ensuring all relevant evidence is gathered

7. Corrective Action Register: Template for tracking implementation of corrective actions

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓƵ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions






























Clauses




















Relevant Industries

Manufacturing

Construction

Healthcare

Transportation and Logistics

Mining and Resources

Agriculture

Retail

Hospitality

Education

Professional Services

Utilities

Warehousing

Maritime

Aviation

Public Sector

Chemical Processing

Forestry

Technology

Relevant Teams

Health and Safety

Operations

Human Resources

Risk Management

Compliance

Quality Assurance

Production

Maintenance

Management

Environmental Health and Safety

Facilities Management

Security

Emergency Response

Relevant Roles

Health and Safety Manager

Operations Manager

Site Supervisor

Human Resources Director

Risk Manager

Compliance Officer

Department Manager

Senior Executive

Project Manager

Safety Officer

Quality Assurance Manager

Factory Manager

Site Foreman

Workplace Health and Safety Coordinator

Environmental Health and Safety Specialist

Facility Manager

Production Supervisor

Safety Consultant

Industries







Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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